PACS:
1. n. (acronym)Picture Archiving and Communications System. A device or group of devices and associated network components designed to store and retrieve medical images.
2. n. (acronym)Pain And Constant Suffering.

Monday, March 28, 2011

I'm assuming GE subcontracted the cowling design to Kia, and they did a very nice job with their Optima as well:

Given the presumed cost of the scanner, I think the car should be included.

I'll let you read through GE's brochure on the 560, which is quite informative. We learn within that:

. . .powerful and versatile, the Optima PET/CT 560 is an all-around remarkable scanner designed to meet the demands of today’s mainstream clinical imaging environment. It’s a scanner we built both for you and around you, by combining superb image quality, high productivity, and a patient–friendly experience. All in a system that can continuously deliver ongoing value for you over time, while helping you maintain high standards of patient safety and care.

A full 2-meter scan range.The Optima PET/CT 560’s carbon fiber table extender enables a full 2-meter scan range–the longest in the industry. You can do a full head-to-toe scan in one pass for greater patient comfort and convenience, and position taller patients on the table with greater ease. Save up to 15 minutes per exam by eliminating patient repositioning–and potentially boost your scanning efficiency and patient throughput. WideView imaging lets you easily see everything in the large, 70-cm bore, giving you more flexibility in positioning patients comfortably for their scans.

Flexible, full FOV imaging.

With GE’S WideView imaging, you can position and image the complete patient in the large, 70-cm bore more comfortably and easily. You get a fully reconstructed, 70-cm field of view for both PET and CT to enable accurate radiation treatment planning–especially critical for obese patients and scans where the skin surface is important.

The brochure emphasizes something extremely, incredibly important, much more so than any scanning or imaging parameter:

Boost your patient volumes and revenues.

Your Optima PET/CT 560 can be operated as a standalone 8- or 16-slice ct scanner. With its exceptional power, remarkable speed, high-resolution/low-dose imaging, and full diagnostic capabilities, it can help increase your patient imaging volumes and revenues.

As a Nuclear Radiologist, there is one thing I want to know about a PET/CT scanner: What crystals are being used in the PET section? As I've outlined in a previous article about the last new GE PET/CT, crystals are critical to PET performance. And GE has, to this point, used what I consider to be the lesser of the commercially-available crystals, bismuth germinate (BGO), as compared to the more advanced cerium-doped lutetium oxyorthosilicate (LSO) crystal found in Siemens scanners.

The fact that GE has chosen not to mention which crystals are used in the new toy make me think that we're probably looking at good old BGO's. If so, that's a deal-breaker for me, period. If not, we can talk. Of course, given the current state of financial affairs, I'm not going to be replacing my Biograph anytime soon.

Friday, March 25, 2011

No doubt you realize that as of today, you are still working to pay your tax bill. Most of us have to work until sometime in late May to pay our share (image courtesy taxfoundation.org):

A corporation in the US is supposed to pay tax as well, up to 35%, one of the highest corporate rates in the world. But wait! Even though all animals are equal on this animal farm, some are more equal than others.

From the NYT (!!!):

(G.E.) reported worldwide profits of $14.2 billion, and said $5.1 billion of the total came from its operations in the United States.
Its American tax bill? None. In fact, G.E. claimed a tax benefit of $3.2 billion.
That may be hard to fathom for the millions of American business owners and households now preparing their own returns, but low taxes are nothing new for G.E. The company has been cutting the percentage of its American profits paid to the Internal Revenue Service for years, resulting in a far lower rate than at most multinational companies.
Its extraordinary success is based on an aggressive strategy that mixes fierce lobbying for tax breaks and innovative accounting that enables it to concentrate its profits offshore. G.E.’s giant tax department, led by a bow-tied former Treasury official named John Samuels, is often referred to as the world’s best tax law firm. Indeed, the company’s slogan “Imagination at Work” fits this department well. The team includes former officials not just from the Treasury, but also from the I.R.S. and virtually all the tax-writing committees in Congress. . .
In a regulatory filing just a week before the Japanese disaster put a spotlight on the company’s nuclear reactor business, G.E. reported that its tax burden was 7.4 percent of its American profits, about a third of the average reported by other American multinationals. Even those figures are overstated, because they include taxes that will be paid only if the company brings its overseas profits back to the United States. With those profits still offshore, G.E. is effectively getting money back. . .
Even as the government faces a mounting budget deficit, the talk in Washington is about lower rates. President Obama has said he is considering an overhaul of the corporate tax system, with an eye to lowering the top rate, ending some tax subsidies and loopholes and generating the same amount of revenue. He has designated G.E.’s chief executive, Jeffrey R. Immelt, as his liaison to the business community and as the chairman of the President’s Council on Jobs and Competitiveness, and it is expected to discuss corporate taxes.
“He understands what it takes for America to compete in the global economy,” Mr. Obama said of Mr. Immelt, on his appointment in January, after touring a G.E. factory in upstate New York that makes turbines and generators for sale around the world. . .

And Immelt's Army knows how to get what G.E. needs:

A review of company filings and Congressional records shows that one of the most striking advantages of General Electric is its ability to lobby for, win and take advantage of tax breaks. . .

The head of its tax team, Mr. Samuels, met with Representative Charles B. Rangel, then chairman of the Ways and Means Committee, which would decide the fate of the tax break. As he sat with the committee’s staff members outside Mr. Rangel’s office, Mr. Samuels dropped to his knee and pretended to beg for the provision to be extended — a flourish made in jest, he said through a spokeswoman.

That day, Mr. Rangel reversed his opposition to the tax break, according to other Democrats on the committee.

The following month, Mr. Rangel and Mr. Immelt stood together at St. Nicholas Park in Harlem as G.E. announced that its foundation had awarded $30 million to New York City schools, including $11 million to benefit various schools in Mr. Rangel’s district. Joel I. Klein, then the schools chancellor, and Mayor Michael R. Bloomberg, who presided, said it was the largest gift ever to the city’s schools.

G.E. officials say the donation was granted solely on the merit of the project. “The foundation goes to great lengths to ensure grant decisions are not influenced by company government relations or lobbying priorities,” Ms. Eisele said.

Mr. Rangel, who was censured by Congress last year for soliciting donations from corporations and executives with business before his committee, said this month that the donation was unrelated to his official actions. . .

G.E. officials say that neither Mr. Samuels nor any lobbyists working on behalf of the company discussed the possibility of a charitable donation with Mr. Rangel. The only contact was made in late 2007, a company spokesman said, when Mr. Immelt called to inform Mr. Rangel that the foundation was giving money to schools in his district.

But in 2008, when Mr. Rangel was criticized for using Congressional stationery to solicit donations for a City College of New York school being built in his honor, Mr. Rangel said he had appealed to G.E. executives to make the $30 million donation to New York City schools.

G.E. had nothing to do with the City College project, he said at a July 2008 news conference in Washington. “And I didn’t send them any letter,” Mr. Rangel said, adding that he “leaned on them to help us out in the city of New York as they have throughout the country. But my point there was that I do know that the C.E.O. there is connected with the foundation.”

In an interview this month, Mr. Rangel offered a different version of events — saying he didn’t remember ever discussing it with Mr. Immelt and was unaware of the foundation’s donation until the mayor’s office called him in June, before the announcement and after Mr. Rangel had dropped his opposition to the tax break.

Asked to explain the discrepancies between his accounts, Mr. Rangel replied, “I have no idea.”

It seems this is nothing new:

In the mid-1980s, President Ronald Reagan overhauled the tax system after learning that G.E. — a company for which he had once worked as a commercial pitchman — was among dozens of corporations that had used accounting gamesmanship to avoid paying any taxes.

“I didn’t realize things had gotten that far out of line,” Mr. Reagan told the Treasury secretary, Donald T. Regan, according to Mr. Regan’s 1988 memoir. The president supported a change that closed loopholes and required G.E. to pay a far higher effective rate, up to 32.5 percent.

That pendulum began to swing back in the late 1990s. G.E. and other financial services firms won a change in tax law that would allow multinationals to avoid taxes on some kinds of banking and insurance income. The change meant that if G.E. financed the sale of a jet engine or generator in Ireland, for example, the company would no longer have to pay American tax on the interest income as long as the profits remained offshore.

G.E. subsequently pointed out what it says is a significant flaw in the story: That the Times did not take into account the impact of its GE Capital losses in the financial crisis. G.E. said that if you exclude GE Capital its tax rate has been about 21 percent.

At his press briefing Friday afternoon, White House press secretary Jay Carney was asked to square Mr. Obama's call for corporate tax reform with his embrace of Immelt. Asked if the story bothered the president, Carney responded that "he is bothered by what I think you're getting at, which is that Americans, I'm sure, who read that story or heard about it are wondering, you know -- you know, how this could be."

I'm bothered, too. I certainly believe everyone should pay their fair share, and not one cent more. But most of us can't lobby Congress to lower our taxes, or (legally) move our profits offshore so as to subvert the system. This doesn't quite smell right, does it, folks?

I threw out the gauntlet with my last post about IT Follies, which prompted the following comment from an anonymous Australian reader via Telstra:

I'm IT manager for a private practice and used to work for a medical software company.

Problems with the software very rarely get fixed unless it is a show stopper. Mouse trails making your screen flicker? Laughable. Developers won't spend their time trying to fix something like that. It is not a good use of their time, unless the contract is up for renewal. Annoying to you but this is the way it is. And small things like this can be ignored because you're locked into a contract for x amount of years, and changing from a PACS/RIS system is a big investment with many things that can go wrong, and the vendors know this.

With regards to the IT support points, I personally do not lock down radiologists systems heavily as they are my bosses. They do know to consult with me before installing anything as many times before installing software can cause unexpected problems. Things like not changing the background; with our agfa systems the background contains important information. IP address, storage cache levels, etc. It saves us (and you) lots of time when having to deal with support calls. I can only assume that is why they don't let you change the background.

Disabling usb ports is a bit extreme, however I have had a workstation crippled due to a virus that got onto the system and interfered with the RIS and PACS (oh, and the user thought disabling the antivirus was a good idea because "it made the system too slow"). In my job, we are afraid to make any change to a doctors reporting station, because if that f***s up, you won't be able to report. The complaint of not having an RSS reader is minimal compared to not being able to work, for example.

Security risks are always a big concern. We're dealing with people's personal medical records. I highly doubt you understand the seriousness of this, and the amount of vulnerabilities in flaws in todays computer systems. Any preventative measure that can be taken to secure a system/network should be. The moment security is breached in your systems - you will be condemning IT for allowing it to happen. (Had this happen a number of times to myself before also, maybe you yourself will be more understanding but others will not).

I also find your use of words to be rather harsh and are kicking up a storm over trivial matters. You earn ridiculous amounts of money and are complaining about "draconian manners" such as disabling right click on the desktop. My heart goes out to you.

Generally, IT know what they are doing (some have no clue, but they are gone after a month or two usually), and the regular users don't. It doesn't sound like you have any relationship with your IT team, and most likely would come across as an overpaid, arrogant doctor with trivial demands. They won't give you the time of day.

Apologies if this is a bit all over the place, typing paragraphs in between other duties here.

Cheers

Wow. Darth Croc definitely has an opinion, doesn't he? Rather than lash out in return, I sent the comment to several of my friends and colleagues.

One of my Australian friends said, "Typically, the default answer (of IT) is “no”. Yet in our private practice, I have IT staff who manage a larger PACS system than the whole of the state public system. . .The difference is that they consider themselves (and are regarded by all) as an important part of the practice, and take pride in what they can deliver. The default answer when a doctor or tech asks is usually (as it should be), is “how can we do it, and what else could we do or combine to make it better, simpler, cheaper or useful for more people?”.

Let it be known that I DO consider IT people (both those within my group and those employed by the hospital) a VERY important part of what I do. Sadly, there are those who don't hold ME and my colleagues in the same regard. Clearly, Darth Croc resents the arrogant, overpaid docs under whom he toils, those who don't understand the seriousness of security.

Mike Cannavo, the One and Only PACSMan, simply said, "but as they say you can't fix stupid so why bother?" Ah, but I must, I must...

My friend, 23 Skidoo, who also has experience with the software end of things, as well as time as a PACS Administrator, is the author of the very well-written X-Ray Vision Blog. 23 Skidoo has this response:

Wow...Well, he/she has some points with respect to vendors only fixing major items...

It is sloppy coding but when it comes down it, I wonder if the problem is more about the CIO/administrators making the final purchase decision instead of the radiologists who have to use the dang thing. I couldn't imagine any radiologist picking GE, particularly after using/demo-ing most other pacs systems...

I don't like the "IT knows what's doing and doesn't need your input" attitude that comes from this person because that indicates a lack of willingness to cooperate. "We know best, and that's that" is what I hear coming from him. I think your main point is not the "smallness" or "bigness" of the issues but the lack of desire on IT's part to even consider cooperation. What they dismiss as small, or in his words "trivial" may be truly small at the computer level, but not on your, life and death, or even just work aggravation level. Perhaps if they took the time to see what you have to do to deal with what they consider small, they just might come around. But it sounds like this person has already made up their mind and is patronizingly treating you like the spoiled child he already presumes you must be, because you are a DOCTOR. Perhaps it's an unconscious or even conscious, passive/aggressive way to lash out at people and throw some authority around. Like TSA agents. TSA is what happens when you give a high school dropout a uniform and a clipboard...

Perhaps if there were more of a spirit of cooperation it wouldn't be such an adversarial US vs. THEM atmosphere and real things could be accomplished. Maybe if they explained to the docs about USB's and viruses, and possibly discussed workable alternate solutions...and gave them heads up when changes were being made instead of sneaking the changes in without any warning docs wouldn't phone in furious. But if one day I can do something and the next day I can't occurs, and no one said a word, I'd be livid. That's patronizing, and wrong. IT folks are not generally known for their ability to communicate to anyone other than machines, and while that is a bit of a harsh stereotype, I have found it to be true. They don't see a reason, (because they have no clue clinically) why they shouldn't do something, take a function away and are "surprised" when they get an onslaught of calls regarding the missing function.

So a better willingness to cooperate and communicate will go a long way for them.. They will get greater compliance with the items they feel they do need to restrict, and gain a better understanding about why they shouldn't do other things.

Both sides need to: Cooperate and Communicate... no condescension....leave attitudes at home.

Well said. My own PACS Guru, who is not at all afraid to say what he thinks, even (especially) if I might disagree with him, comments thusly:

I think the response should be to politely let him know that you do have a higher than normal understanding of both IT and the security risks involved when dealing with patient records. Tell him that IT personnel that understand what is required to deal with and keep a PACS running and secure without putting up roadblocks that inhibit it's functionality and the users ability to do everything needed so they can take care of patients are the EXCEPTION rather than the rule. Most IT departments are only concerned with the security NOT the usability with a system. It's like welding a Porsche into the garage to protect it.

The animosity and arrogance he displayed in his post IS the norm for IT folks and that too is part of the problem. You can also tell him that your group's IT/PACS team doesn't seem to have a problem protecting your machines,servers, or network without locking your machines down to the point of being unusable.

I think we have the proper responses to Darth Croc. Many thanks to my guest contributors. When you have friends like mine, it's really easy to write a blog!

As I've said at every opportunity...PACS is a team effort. We need cooperation and discussion to go forward. The Rads, the Vendors, and IT all need to work together to HELP OUR PATIENTS. That's what it's all about, folks. I've tried to spread this message everywhere from Perth to the Deep South, but I'm not sure everyone is listening.

Still, saving a life does take precedence over saving the integrity of a computer, at least in my book.

Tuesday, March 22, 2011

Having just visited a friend in need, Mrs. Dalai and I decided to keep on driving, and found ourselves in this sub-tropical beach paradise. There's nothing like a few days of R&R with sun, sand, and a few Landsharks to keep us going.

But I can never quite leave the office and PACS completely at home (although I'll give it a good try this summer).

A thread on AuntMinnie.com started by Midwest Eastern Rad has been gnawing at me for a while, and now is as good a time as any to grace you with my thoughts on the subject. M.E.R. sounds a bit like me and some of my partners, not to mention some of my friends around the world:

I want a discussion relating to one's attempting to change workflow (improving ergonomics) vis-a-vis institution reluctance to adapt and change.

Basically, how can a radiologist supplement the "out of the box" software settings for workstation to work in his/her favor, by creating personalized more ergonomic workflows? This can involve hardware--such as your own USB mouse with programmable buttons, or an input device such as a gaming mouse or ShuttlePro. Can involve Windows display or mouse settings. Also may involve installing small software programs on the host computer (macro programs, mouse software in order to program the buttons). This is all driven by wanting to reduce repetitive motions, reduce mouse clicks, avoid eye strain (i.e. increase DPI on 5 MP monitors so you can actually read the text or increase text size, all Windows properties), reducing excessive mouse motion (i.e. 3,4,5 monitors vs. 2), and trying to rid myself of the body aches that I have gotten from work.

My experience has been that IT support has no interest, and I don't want to be problem for them, but I need to take it on myself to improve ergonomics, and don't know how to proceed. The manufacturers (PACS, VR, hardware) also have no interest that I have found.

How do people deal with trying out new devices, new workflows, changes in the PACS settings, automated steps (macro creation) to try to eliminate the excessive number of mouse clicks that we undergo when using PACS (and RIS)? I ask this especially in light of the restrictions that IT people put on the PACS workstations to not allow access to key areas in Windows OS or even locking down USB plugs, programs, windows, etc. Do you do it "behind the back" of IT? What if there is lockdown? How much do you fight for yourself?

If IT does not wish to work with you (which I suspect many IT people do not want to do because it complicates their lives), how do you proceed? If we all stayed stagnant, we'd be doing the same thing we did 50 years ago, yet often, I find that pushing the envelope on standard workflow gets you into trouble. Hard to put into words, but I'd love to hear comments.

Gee, M.E.R., this sounds rather familiar, and I haven't even tried to do anything with mice or other hardware enhancements. I have, however, had they joyous experience of having my right click cut off by IT so as to keep me from defacing the desktop's AGgravating logo from their FAvorite vendor. (Fortunately, I'm much more resourceful than that, and it turns out to be rather simple to circumvent this little problem.) I was also told that I couldn't deploy a simple macro to keep open a RIS window that would otherwise close after 30 minutes because someone might use the program to circumvent a password entry. I'm reminded of my friends in Western Australia, whose IT departments progressively cut off all input paths to their workstations so as to block the installation of a "foreign" PACS client, as this might "void the warranty".

Do read the various responses to Midwest's post. Of course, I have some comments on the topic as well.

The friction between Radiology and IT is a world-wide phenomenon. You should have heard the chuckling and grunts of agreement when I presented Dalai's XIth Law of PACS at RANZCR in Perth last year:

XI. If IT doesn’t like something, it will be termed a security risk.

And herein lies the rub. Actually, there are a number of problems, really, which fall into several general categories. One or more may apply at your particular shop.

IT doesn't want to do the work of accommodating the rads.

IT has a paranoid-level level of anxiety about any possible security breach.

The vendor has made life difficult via threats of voiding the warranty and/or FDA certification.

IT is afraid of what any (and I mean ANY) change might do to the vendor's software.

Before we go any further, two elements need to be brought to the forefront of the discussion. First, everything we do is intended to promote patient care. Second, we all need to work together toward that end.

I have what IT might consider a biased view: PACS exists to help the radiologist perform his or her job of caring for the patient. It is frankly asinine for IT to take complete ownership of PACS in such a draconian manner as to limit its use to whatever IT thinks appropriate. This is not acceptable. I am the radiologist. I have to use this technology to care for my patients. I am the one who will face legal remedies if something goes wrong. There is no justification for being told "NO" when asking for something reasonable.

But I'll be conciliatory here. Not every idea is a good one, even those hatched in my devious little mind. Some might possibly impact security. Not many, but maybe some. And some might truly interfere with PACS software. Which gets us into another discussion.

PACS software is extremely complex, lying somewhere on the continuum between Microsoft Office and Windows 7. Now, give me an honest answer: If Word acted weird when you plugged in a new mouse, would you blame: a. Yourself for being such a stupid fool as to have tried this; b. Your computer for malfunctioning; or c. Microsoft for writing poor code. I'm picking c. You would be on the phone to Bangalore immediately trying to get Microsoft to fix their glitch. And if Peggy on the other end of the phone tried to tell you that your plugging in the non-Microsoft mouse might have voided your warranty, you would jump through the phone all the way to whatever subcontinent was appropriate.

Microsoft Office runs about $150 for the home version. The average PACS runs about $250,000 at the minimum. Why do we tolerate bad behavior from such an expensive product? Good question. Ask your IT people.

But this is what I mean by being conciliatory. There is a kernel of truth in IT's fear of something interfering with the PACS software, because that software might not be properly written. I've seen this happen firsthand. Our IMPAX system went wacky on the third monitor's color display when I activated "mouse trails" to better see the cursor. That, folks, is a software glitch, and tells us that something wasn't written correctly. Maybe there was a shortcut in some video card call, maybe there is some strange memory leak, or maybe "mouse trails" somehow interferes with the electrical stimulation of the gnomes that live in the CPU. Whatever. This tells us there is a glitch. I don't have to wonder if some of our other problems are due to similar weirdness. I'm of the opinion that every manifestation of this sort of thing discloses bad programming on the vendor's part until proven otherwise. Period. Thus, IT needs to work with us to identify these things, and demand patches or updates when we find them. The easiest solution, having IT lock down everything simply to avoid this sort of thing, is not the best solution, nor is it at all acceptable.

And for the record, I believe the ideal way to go forward is to work together. I've said that many times. We, the users of PACS, our IT support, and the vendors all need to coordinate our efforts. I'm not asking anyone to rewrite all PACS software to work the way I want it to work. I've found that more or less in AMICAS 6 (there are some glitches even in this program but Merge is actually listening to me and others to effect improvements), but several of my partners still pine for version 5. This goes to show that you can't totally please everyone at all times. I do have faith that my colleagues will come around to my way of thinking, or I'll throttle them. But if what happened to Midwest Eastern Rad EVER happens in one of my shops:

Well, to make matters worse, the IT folks have now disabled our "Display properties" tab on Windows, so we can no longer adjust text size larger, smaller, disable monitors, etc. When I called and asked why, I was given a very terse answer, something like "part of the lockdown".

I asked why again, and was hung up on.

I wouldn't rest until I have the head (or at least an apology) from the miscreant in question. As Xrayer31 put it:

Sounds to me like your hospital IT dept. has forgotten how their salary gets paid. I believe billing for performed medical procedures is what gets it done. They aren't treating you like the customer you are. Hanging up on you? Who are these trolls? Too busy? What are they doing, arguing over whether Star Trek or Star Wars is the coolest? Time to take it up the chain and report not only the poor customer service, but blatent disrespect and unprofessional behavior.

Wednesday, March 16, 2011

Certain larGE companies seem to have something to do with just about anything and everything.

We have all watched with fascination and horror the televised images of the Japanese earthquake, the tsunami that ensued, and the aftermath of both. In particular, those of us whose bills are paid by radiation have followed the potential tragedy at the Fukushima Daiichi electrical station with almost morbid interest. Personally, I'm rather frustrated by the limited information available to the public. Exactly what has been vented into the atmosphere? Iodine? Cesium? What is the temperature of the reactor cores? And so on. But I'll leave that sort of thing for the main outlets, as I have no inside information on any of it.

Some of those same mainstream outlets are giving us some unusual pieces of information, some tidbits that are not complementary to the Administration's favorite larGE company. It seems that the reactor in use was designed by said company in the 1960's. . .

The warnings were stark and issued repeatedly as far back as 1972: If the cooling systems ever failed at a “Mark 1” nuclear reactor, the primary containment vessel surrounding the reactor would probably burst as the fuel rods inside overheated. Dangerous radiation would spew into the environment.

Now, with one Mark 1 containment vessel damaged at the embattled Fukushima Daiichi nuclear plant and other vessels there under severe strain, the weaknesses of the design — developed in the 1960s by General Electric — could be contributing to the unfolding catastrophe.

When the ability to cool a reactor is compromised, the containment vessel is the last line of defense. Typically made of steel and concrete, it is designed to prevent — for a time — melting fuel rods from spewing radiation into the environment if cooling efforts completely fail.

In some reactors, known as pressurized water reactors, the system is sealed inside a thick steel-and-cement tomb. Most nuclear reactors around the world are of this type.

But the type of containment vessel and pressure suppression system used in the failing reactors at Japan’s Fukushima Daiichi plant is physically less robust, and it has long been thought to be more susceptible to failure in an emergency than competing designs. In the United States, 23 reactors at 16 locations use the Mark 1 design, including the Oyster Creek plant in central New Jersey, the Dresden plant near Chicago and the Monticello plant near Minneapolis.

G.E. began making the Mark 1 boiling-water reactors in the 1960s, marketing them as cheaper and easier to build — in part because they used a comparatively smaller and less expensive containment structure.

American regulators began identifying weaknesses very early on.

In 1972, Stephen H. Hanauer, then a safety official with the Atomic Energy Commission, recommended that the Mark 1 system be discontinued because it presented unacceptable safety risks. Among the concerns cited was the smaller containment design, which was more susceptible to explosion and rupture from a buildup in hydrogen — a situation that may have unfolded at the Fukushima Daiichi plant. Later that same year, Joseph Hendrie, who would later become chairman of the Nuclear Regulatory Commission, a successor agency to the atomic commission, said the idea of a ban on such systems was attractive. But the technology had been so widely accepted by the industry and regulatory officials, he said, that “reversal of this hallowed policy, particularly at this time, could well be the end of nuclear power.”

In an e-mail on Tuesday, David Lochbaum, director of the Nuclear Safety Program at the Union for Concerned Scientists, said those words seemed ironic now, given the potential global ripples from the Japanese accident.

“Not banning them might be the end of nuclear power,” said Mr. Lochbaum, a nuclear engineer who spent 17 years working in nuclear facilities, including three that used the G.E. design.

Questions about the design escalated in the mid-1980s, when Harold Denton, an official with the Nuclear Regulatory Commission, asserted that Mark 1 reactors had a 90 percent probability of bursting should the fuel rods overheat and melt in an accident.

Industry officials disputed that assessment, saying the chance of failure was only about 10 percent.

Michael Tetuan, a spokesman for G.E.’s water and power division, staunchly defended the technology this week, calling it “the industry’s workhorse with a proven track record of safety and reliability for more than 40 years.”

Mr. Tetuan said there are currently 32 Mark 1 boiling-water reactors operating safely around the globe. “There has never been a breach of a Mark 1 containment system,” he said.

Several utilities and plant operators also threatened to sue G.E. in the late 1980s after the disclosure of internal company documents dating back to 1975 that suggested that the containment vessel designs were either insufficiently tested or had flaws that could compromise safety.

The Mark 1 reactors in the United States have undergone a variety of modifications since the initial concerns were raised. Among these, according to Mr. Lochbaum, were changes to the torus — a water-filled vessel encircling the primary containment vessel that is used to reduce pressure in the reactor. In early iterations, steam rushing from the primary vessel into the torus under high pressure could cause the vessel to jump off the floor.

In the late 1980s, all Mark 1 reactors in the United States were also retrofitted with venting systems to help reduce pressure in an overheating situation.

It is not clear precisely what modifications were made to the Japanese boiling-water reactors now failing, but James Klapproth, the chief nuclear engineer for General Electric Hitachi, said a venting system was in place at the Fukushima plants to help relieve pressure.

The specific role of the G.E. design in the Fukushima crisis is likely to be a matter of debate, and it is possible that any reactor design could succumb to the one-two punch of an earthquake and tsunami like those that occurred last week in Japan.

Although G.E.’s liability would seem limited in Japan — largely because the regulatory system in that country places most liability on the plant operator — the company’s stock fell 31 cents to $19.61 in trading Tuesday.

From ABC News comes this piece, citing an insider to the design, someone whose futile attempts to warn those in charge are eerily remniscent of the Challenger fiasco:

Thirty-five years ago, Dale G. Bridenbaugh and two of his colleagues at General Electric resigned from their jobs after becoming increasingly convinced that the nuclear reactor design they were reviewing -- the Mark 1 -- was so flawed it could lead to a devastating accident.

Questions persisted for decades about the ability of the Mark 1 to handle the immense pressures that would result if the reactor lost cooling power, and today that design is being put to the ultimate test in Japan. Five of the six reactors at the Fukushima Daiichi plant, which has been wracked since Friday's earthquake with explosions and radiation leaks, are Mark 1s.

"The problems we identified in 1975 were that, in doing the design of the containment, they did not take into account the dynamic loads that could be experienced with a loss of coolant," Bridenbaugh told ABC News in an interview. "The impact loads the containment would receive by this very rapid release of energy could tear the containment apart and create an uncontrolled release."

. . . GE told ABC News the reactors have "a proven track record of performing reliably and safely for more than 40 years" and "performed as designed," even after the shock of a 9.0 earthquake.

Still, concerns about the Mark 1 design have resurfaced occasionally in the years since Bridenbaugh came forward. In 1986, for instance, Harold Denton, then the director of NRC's Office of Nuclear Reactor Regulation, spoke critically about the design during an industry conference.

"I don't have the same warm feeling about GE containment that I do about the larger dry containments,'' he said, according to a report at the time that was referenced Tuesday in The Washington Post.

"There is a wide spectrum of ability to cope with severe accidents at GE plants,'' Denton said. "And I urge you to think seriously about the ability to cope with such an event if it occurred at your plant.''

Bridenbaugh told ABC News that he believes the design flaws that prompted his resignation from GE were eventually addressed at the Fukushima Daiichi plant. Bridenbaugh said GE agreed to a series of retrofits at Mark 1 reactors around the globe. He compared the retooling to the bolstering of highway bridges in California to better withstand earthquakes. . .When asked if that was sufficient, he paused. "What I would say is, the Mark 1 is still a little more susceptible to an accident that would result in a loss of containment."

GE’s thoughts and condolences continue to be with the people of Japan affected by the devastating impact of last Friday’s unprecedented natural disaster. And GE officials continue to closely monitor the events at the Fukushima Daiichi Power Plant, which suffered a loss of power after the tsunami struck the site.

During the magnitude 9.0 earthquake (the fifth largest earthquake in recorded history), the GE Boiling Water Reactors (BWR), performed as designed and initiated safe shut down processes. We understand that the back-up generators performed as designed to begin the cooling process. Shortly thereafter, we understand that the tsunami disabled the back-up emergency generation systems.

The fleet of GE Hitachi Nuclear Energy (GEH) BWR reactors has a proven track record of performing reliably and safely for more than 40 years.

GE has been in the nuclear industry for more than half a century. There are currently 92 GE-built BWR plants and plants using the licensed GE BWR design operating globally. Our BWR designs meet the rigorous regulatory requirements of the U.S. Nuclear Regulatory Commission (NRC) and other government regulators and have proven to be safe and reliable. Our reactors are one of the workhorses of the industry.

The Unit 1 reactor at the Fukushima Daiichi site went into commercial operation in 1971; it is a BWR-3, with a Mark I containment system. That means that the reactor is the third generation of the BWR design. The reactor in Unit 1 is the same type as several reactors in the U.S., although every reactor is designed specifically for each project and site. All GEH BWR designs meet all NRC requirements for safe operation during and after an earthquake for the areas where they are licensed and sited.

BWR reactors are designed to be able to safely shutdown in the event of an earthquake or other natural disaster.

A rather bare-bones explanation, but I wouldn't be saying too much at this point, either.

Is there any culpability here? We will probably never know. But as usual, it all really comes back to listening. To your employees with expertise in such areas. Or to your customers. It is all about remembering that one's ego, personal or corporate, needs to end where the life and livelihood of others begins.

It's rather ironic, really. No one would have been at all surprised had the containment vessels ruptured outright in the 9.0 earthquake. That would have been tragic, but acceptable at some level. After all, the structures were never designed to withstand that sort of an impact. But since the reactors did survive, only to fail from what may be a lesser design flaw, the pressure is on (pun intended).

Friday, March 04, 2011

I have never made it to the Healthcare Information and Management Systems conference, better known as HIMSS, and I suspect I never will. My friend Mike Cannavo, the One and Only PACSMan, did attend this year, primarily because it was in his backyard, I suppose, and renders this report on his illustrious blog.

Based on Mike's review and others like it (well, there aren't any others quite like it but...), it seems that HIMSS has strayed mainly into the realms of informatics, numbers, demographics, and the like, and away from PACS and the picture-based information we radiologists know and love. Heck, even SiiM is getting too esoteric for the likes of me.

There were some interesting sights at HIMSS, however, according to Mike:

Best Marketing- without a doubt XLR8r. They had it together.Worst Marketing- No names will be used to protect the guilty, but it deals with infection control and I’ll leave it at that. I wish I could have taken a picture but guys tend to frown on you when you bring a camera in the men’s room so you’ll have to take my word on this one. I’m standing there getting rid of the morning's coffee and look down and there, written on the urinal screen, is the message “Your keyboard is 4 times dirtier that this” (or something like that). I’m like- “Is NOTHING sacred any more?” Now I’ve been in sports bars and such where they had the newspaper sports section posted above the urinal so you can look at the headlines while you take a leak but the urinal screen? And I really didn’t want to argue with the guys but in the absence of a disease condition urine is basically sterile and is greater than 95% water, with the remaining constituents, in order of decreasing concentration urea 9.3 g/L, chloride 1.87 g/L, sodium 1.17 g/L, potassium 0.750 g/L, creatinine 0.670 g/L and other dissolved ions, inorganic and organic compounds so what’s so dirty about a little pee. If it was good enough for Gandhi it’s good enough for me…. But alas I digress lest someone say I’m full of piss and vinegar.